View ESA-OWCP's Form 1215-0176 Online
Agency: |
ESA-OWCP |
Title: |
Uniform Billing Form |
Form Description: |
OWCP-04, Uniform Billing Form: This information is required to reimburse health care providers for services rendered to injured employees covered under OWCP-administrative programs |
OMB Control Number: |
1215-0176 |
OMB Expiration Date: |
Sunday, January 31, 2010
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